Lesser blows now the big concern with regard to concussions

Player 120 blew everything out of the water for Purdue concussion researcher Larry Leverenz.

In a study of high school football players, Leverenz equipped their helmets with G-force detectors. He did baseline functional MRI exams of their brain and administered cognitive tests on all the participants a week before two-a-days began to establish baseline "normal" references on each participant. Then he repeated the testing throughout the season, trying to establish concussion data.

However, it was the player who never got a concussion that changed everything. Player 120 never blacked out despite weathering more than 150 blows a week. He reported none of the traditional concussion symptoms. He seemed lucid, never staggered off the field and never experienced headaches. But scans of his brain showed decreased function. Cognitive testing showed a similar dive in visual and verbal scores from his baseline test.

His brain returned to almost normal in postseason scans. But the fact his brain was showing something no one could see during the season was frightening. He wasn't the only non-concussion player to experience similar decreases in brain function.

"We thought we screwed up. We thought something was wrong," Leverenz said. "I remember the day we put it all together, and I said, 'No, you've got to be kidding."

Leverenz took the results to a neurosurgeon.

"All of us kind of had the same initial reaction," Leverenz said. "We said, you know, these kids never come out of a game. We would never identify these kids. There is no way right now to identify this group."

Leverenz , Dr. Julian Bailes from West Virginia University and Dr. Ann McKee of Boston University presented evidence Tuesday in the National Athletic Trainers' Association Meeting and Clinical Symposia that this unseen, undiagnosed injury -- "sub-concussive blows" -- could be dangerous.

Bailes detailed various evidence that repeated hits to the head alter brain structure and function. Sub-concussive blows are part of that.

"It's a concept that is worrisome, and we need to have much further study, but it doesn't rise to the level to a known, recognized or diagnosed concussion," Bailes said. "Are there blows that are occurring, and are they too many, and or at the wrong time or on top of each other, could they cause long-term problems? Perhaps. That's why we want to work to get the head out of the game."

Bailes wants organizations to consider changing the rules in football to limit hits to the head. He went so far to suggest taking linemen out of three-point stances and rethinking the idea of the smashing of facemasks that defines line play. He presented accelerometer data that showed linemen can sustain hits of 20 to 30 Gs on every play.

"The (HITS) system (the Purdue study used) measures anything over 14 Gs; a pretty hard auto collision is like 20 Gs," Leverenz said. Forces of about 90 to 100 Gs are risky for concussions and could cause death. Leverenz said his study-equipped helmets registered a few blows of more than 100 Gs.

But more than those big hits, it's the frequent, lesser hits that are taking center stage in athletic brain injury research. Leverenz said he works closely with engineers who can now detail the physics of how the brain moves in response to blows, even if they don't show on the outside.

"They talk about how this concussive wave deforms the brain without the head ever moving," Leverenz said. "Those kinds of things we are trying to look at."

McKee finished the presentation with what the end stage of this unrecognized condition, as well as the concussion-riddled former athlete, might look like. She spoke about Chronic Traumatic Encephalopathy, a degenerative condition that is directly linked to repeated head hits.

In collecting 80 brains of athletes and military veterans the past three years, McKee found the brains of CTE patients riddled with the Tau protein, which disrupts the normal function of cells.

Former NFL players John Grimsley, Dave Duerson and Kevin Turner all were diagnosed post-death with CTE. All three experienced emotional and behavior changes after retiring. All three had head injuries. All three had Tau protein wrapped all over their brains.

There is no test to diagnose the condition in living athletes, and there is not enough research to determine how those such as Player 120 might be at risk for such outcomes. "They're seeing the end of the road, we're looking at the beginning," Leverenz said. "Right now, the only way you can diagnose CTE is death with an autopsy. We want to know when CTE begins or how can we diagnose that beginning. We're talking to them about what kind of protocols we might use."